Is this good news ?

[Crabcake Johnny]

Another sucker bet.

Sounds good, but what about quality of care? How do you develop metrics to compare cost with quality?

Control costs then the price of health insurance will come down.

Transparency only works on primary care. The human body is too complex to develop an accurate fee schedule for anything much beyond primary care.

When you have a heart attack or cancer are you going to go online and look for the lowest price?

I doubt it.

Agree and disagree. If I'm driving through Arkansas and my car dies I might only get towed to the nearest...and only shop and get whacked with $3,000 in repairs - then it is what it is.

However, back home if my car needs any service work or breaks down then I can shop.

You can bet one doctor in my town charges $100 for a visit and another charges $180 for the exact same services - however I cannot go online to compare.

You can get a basic idea of transparency here - which is where we now go for basic care:

Treatment and Cost at MinuteClinic

PERFECT example: $59 to treat an ear infection at Minute Clinic. I have re-priced bill from over a year ago at the doc's office for just over $110.

Quality? You know what's entailed when you see a doctor for an ear infection. The doctor looks into my son's ear - says "yep, ear infection" writes out the script and we're out.

But now, for heat attacks, strokes, etc...you're not going to go online.

Now let's take my brother's current situation - stroke victim and he's home now going to rehab 3 hours a day, 3 days a week.

The hospital simply gave him the address of the rehab center and said "you start here tomorrow." Say what? There's one rehab center in Maryland? Let's go online, see all the rehab centers in his area and compare some prices.

That's where we need to be.

 

[bill3173]

Another sucker bet.

Sounds good, but what about quality of care? How do you develop metrics to compare cost with quality?

Control costs then the price of health insurance will come down.

Transparency only works on primary care. The human body is too complex to develop an accurate fee schedule for anything much beyond primary care.

When you have a heart attack or cancer are you going to go online and look for the lowest price?

I doubt it.

What about dentists? Do you think transparency will help there? Their prices have gone through the roof in recent years, and without saying anything more, they are reaping the rewards, big. I've actually become more sympathetic with the average physician. Not talking about the fancy pants.

I do not want to preach antidentitism, we know what happened to Seinfeld, but you can get away from a plastic surgeon cheaper than some dentists.

 

[Tina]

What about dentists? Do you think transparency will help there? Their prices have gone through the roof in recent years, and without saying anything more, they are reaping the rewards, big. I've actually become more sympathetic with the average physician. Not talking about the fancy pants.

I do not want to preach antidentitism, we know what happened to Seinfeld, but you can get away from a plastic surgeon cheaper than some dentists.

A lot of this info is available, you just need to ask for it.

There are a couple national, "brand name" type dentist offices that have the prices posted upfront, others you just call and ask. The assistant who answers the phone will tell you (they tend to also do the billing so they know).

I've also found it to be true with Dr's. No, you can't comparison shop on line, but if you ask for it, they will give you the billing info. They know what they're charging you for in most cases when you make the appointment, and if it's routine care, if the Dr has a good office staff, they will know within $20 what it will cost you. They may not know what the health insurance, discounted price is, but they know the billing code and you can call the insurance company and ask (part of the reason you can't comparison shop on line) if it's something more pricey.

That's what I did what I needed a couple procedures for my back. I got the billing codes for each step from the office staff and what the charges would be without insurance, called the insurance company found out what I would be billed. Also found out the contracted rates saved me about 2k each visit

 

[Crabcake Johnny]

The dentist wants to replace my wife's fillings with crowns - and printed off a very detailed break-down of the costs.

Try getting that from a hospital when you're scheduled for a simple outpatient procedure.

 

[somarco]

Now let's take my brother's current situation - stroke victim and he's home now going to rehab 3 hours a day, 3 days a week.

The hospital simply gave him the address of the rehab center and said "you start here tomorrow." Say what? There's one rehab center in Maryland? Let's go online, see all the rehab centers in his area and compare some prices.

I would assume a case manager would be involved here.

The Minute Clinic confirms what I said about transparency on primary care. That's a no-brainer.

But do you really want to shop for the lowest price on care for a major illness?

Should be easy enough to get a list of par providers from the carrier, then visit to see which ones are suitable. But price shopping for major care is something where we will have to disagree.

What about dentists? Do you think transparency will help there?

Possibly.

There are places like Coast that publish prices for some things. Problem is, fewer than 20% of dentists are par providers. So you have 80%+ that don't discount and have no reason to publish pricing.

 

[Guest]

Hi Tina, how did you get the billing codes?

I was told by more than one insurer that they didn't even have access to that information (CTP codes).

That's what I did what I needed a couple procedures for my back. I got the billing codes for each step from the office staff and what the charges would be without insurance, called the insurance company found out what I would be billed. Also found out the contracted rates saved me about 2k each visit

 

[Tina]

Hi Tina, how did you get the billing codes?

I was told by more than one insurer that they didn't even have access to that information (CTP codes).

For my primary Dr, I get the billing codes from the front desk. For anything routine they have them.

Your right, insurance companies don't have the billing code info. The Dr's billing dept does. For what I had done to my back, I got the "official" procedure name that the Dr office submits to their billing dept from the front desk. Then I called the billing dept and got the codes from them. Once I had the codes, I called the insurance company and got the contracted price.

I started where you did with the insurance company as well. Took me about 2 days, 30 voicemails and return calls to figure out the system to get the info. Took me about a day to get the codes because you have to wait for people to call you back. Once you have the codes though, the insurance company can look the info up right away and give you a price

 

[somarco]

You can get CPT4 codes from your provider. And you can call your carrier and get an idea of the price.

That works for "clean" procedures, particularly outpatient. Inpatient is a different story.

You can also take your CPT codes to a CMS site (can't remember which one now and don't have the desire to go hunting) and get a DRG price for Medicare patients. Add 40% to the DRG and that will get you in the ballpark of a PPO per diem allowance for some procedures.

 

[retread]

You can get CPT4 codes from your provider. And you can call your carrier and get an idea of the price.

That works for "clean" procedures, particularly outpatient. Inpatient is a different story.

You can also take your CPT codes to a CMS site (can't remember which one now and don't have the desire to go hunting) and get a DRG price for Medicare patients. Add 40% to the DRG and that will get you in the ballpark of a PPO per diem allowance for some procedures.

So now you tell me... I spent several hours last month chasing down this info!!

 

[Crabcake Johnny]

You can get CPT4 codes from your provider. And you can call your carrier and get an idea of the price.

That works for "clean" procedures, particularly outpatient. Inpatient is a different story.

You can also take your CPT codes to a CMS site (can't remember which one now and don't have the desire to go hunting) and get a DRG price for Medicare patients. Add 40% to the DRG and that will get you in the ballpark of a PPO per diem allowance for some procedures.

Regarding quality of care - with transparency as long as you're in-network you should be fine. Networks have to certify and re-certify physicians and hospitals.

I think you're suggesting that with price transparency it might be possible for one hospital to provide "poor" treatment for cancer - stroke - heart attack? That would never be the case.

Potential litigation involved in providing substandard care for major condition would prevent substandard care.